Racial disparities a ‘harsh reality’ in breast cancer care
As the United States enters an era of precision medicine in oncology, it is important that the racial disparities that currently exist in breast cancer care do not leave certain populations behind, according to an expert.
In an interview with Healio, Naomi Ko, MD, MPH, assistant professor of medicine at Boston University School of Medicine and medical oncologist at Boston Medical Center, discussed how disparities in care disproportionately affect Black and Brown women with breast cancer, the need for better representation of these patient populations in clinical studies, ways to address these issues and more.
Healio: Are there significant differences in incidence or rates of breast cancer for Black patients compared with patients from other racial/ethnic backgrounds?
Ko: Unfortunately, when compared with other races in the United States, Black women suffer worse breast cancer outcomes. This persistent disparity has been an ongoing challenge for decades. For many years, Black women had a lower incidence rate of breast cancer, but in the last 5 years, we have seen that the incidence rate has converged and remained close — but a persistent difference in mortality remains.
Healio: Are there differences in prognosis and outcomes for Black patients compared with patients from other racial/ethnic backgrounds?
Ko: Yes, precisely. The problem is that Black women are 40% more likely to die of breast cancer when compared with white women. This disparity has been well known for years, with decades of research demonstrating this persistent, stubborn and harsh reality.
Healio: What are the potential contributors to these disparities? Do differences in screening, socioeconomic status, barriers to care, biology or genetics play a role?
Ko: All of the above! Health equity in breast cancer requires interventions from multiple levels — patient, provider, hospital, community and society. In disparities research, we have frameworks that can help to guide intervention work that can make incremental changes at each of these levels. No magic bullet will fix this problem. Put another way, we need solutions that are necessary but insufficient. Moreover, we need to be persistent in our mission to ensure that all women have an equal chance at a cure.
Healio: Are Black patients more or less likely to receive certain treatments?
Ko: An individual patient’s ability to receive certain treatment depends on a myriad of factors, such as where they live or if they have insurance. Additionally, treatment may depend on whether patients can take time off work, have a ride to the clinic, trust their medical team and hospital, understand why their providers are recommending the treatment, or get side effects — or if they have another illness that makes it difficult to sustain treatment. Now, if you think about race and poverty, they are co-linked. The social determinant of health can play a tremendous role in whether Black patients will be able to get, electively choose and sustain treatment.
Healio: What other disparities exist in breast cancer care with regard to race or ethnicity?
Ko: Our Black and Brown patients who also live in poverty or who have fewer social and emotional supports suffer more barriers to getting optimal treatment. For many of these patients, cancer simply isn’t their biggest problem. And, in my experience, these women are often working hard to care for everyone else except themselves.
Healio: Is there adequate representation of racial/ethnic groups within study populations?
Ko: This is an issue that we must address and solve as soon as possible. I see this as a top priority. The astounding research happening in breast cancer, and in all of oncology, is unprecedented. As the science and research explodes, we are in the era of precision medicine and incredible laboratory techniques to improve our knowledge of individual tumors and tumor microenvironment. But if racial/ethnic groups are not well represented in these studies, at best, we are missing an important responsibility to ensure that the scientific and medical findings are generalizable to all patients. At worst, we will see the disparities gap between Black and white patients widen.
Healio: How can health care providers address these disparities in care?
Ko: Every health care provider can play a role in health equity. Our nation is going through a racial reckoning.
I humbly suggest that, first, health care providers take a moment to reflect on their own position in society or place in the community. Second, I suggest they be genuine, curious and open to the perspectives of those around them. Finally, I suggest that, based on what resonates with them individually, they consider getting involved on a level that feels right for them. Reach out to providers and institutions where racial and ethnic minority patients seek care; partner with these cancer care teams; encourage racial minority patients to enroll in a clinical trial and/or donate specimens for cancer research; write to local elected officials to change laws or write laws to support health equity. Every and any participation matters! Reach out to me and I would love to help.